Project Summary/Abstract The paradox of colorectal cancer (CRC) screening is that healthy older adults are often under-screened and those in poor health are over-screened. One study found that 51% of US adults >75 years with < 10 years of life expectancy were screened while 62% with >10 year LE were not. Guidelines recommend that adults >75 years make individualized decisions based on expectations of benefits, harms, values, and preferences. There is a gap in existing decision aids (DAs) designed for low health literate (LHL) adults >75 years to assist in making CRC screening decisions. This is concerning since risk factors (>75 years, low socioeconomic status, low educational levels, racial/ethnic minority status) for LHL are associated with low CRC knowledge of screening options, low self-efficacy, an apparent lack of desire to participate in SDM, and with less than optimal screening. The primary objective for this K23 application is to optimize CRC screening decisions and improve the quality of care among LHL adults 76-85 years with attention to differences by sex. The specific aims are to: 1. Identify the information needs and perceptions of LHL older adults about CRC screening; 2. Develop and modify short, paper-based pamphlet CRC DA for use with LHL older adults; and 3. Conduct a feasibility pilot randomized control trial of the CRC DA. Mixed qualitative (structured interviews, focus groups) and quantitative methods will be used to evaluate and test the ?Making a decision about colon cancer screening? DA to create a simple, effective DA tool for use among cognitively intact older adults with LHL in four community based settings and three community health centers. The candidate's long-term goals are to become an independent health services researcher who develops health promotion interventions and improved decision support for underserved and underrepresented older adults with low health literacy. and secure independent research funding through NIH R01's and related awards such as ?Increasing Uptake of Evidence-Based Screening in Diverse Adult Populations (PAR-18-932)? and ?Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults; PA-17-109.? To the meet the research objective and career goal, the three training goals are to receive advanced training in:1. Developing skills in health literacy/health communication using mixed methodology; 2. Learning how to develop and evaluate decision support for LHL older adults; and 3. Designing and conducting randomized control trials. The research and career development will take place at Simmons University School of Social Work in collaboration with the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, where the candidate's primary mentor is located. The combination of resources at both institutions provide a very rich intellectual environment with relevant expertise to contribute substantially to the probability of success of the proposed study.